RISK-FACTORS FOR FALLS AS A CAUSE OF HIP FRACTURE IN WOMEN
RISK-FACTORS FOR FALLS AS A CAUSE OF HIP FRACTURE IN WOMEN
复制标题
DOI：
10.1056/nejm199105093241905
复制
发表时间：
1991-05-09
影响因子：
158.5
通讯作者：
KAPLAN, F
中科院分区：
文献类型：
--
作者：
GRISSO, JA;KELSEY, JL;KAPLAN, F
背景。 尽管即使在老年人中，大多数跌倒也与骨折无关，但超过 90% 的髋部骨折是跌倒造成的。 很少有研究评估跌倒的危险因素是否也是髋部骨折的重要危险因素。方法。 为了研究跌倒危险因素在髋部骨折流行病学中的重要性，我们对纽约和费城 30 家医院中的 1 家因首次髋部骨折入院的 174 名女性（中位年龄为 80 岁）进行了病例对照研究。 根据年龄和医院与病例匹配的对照是从普通外科和骨科医院服务中选择的。 信息是通过直接访谈获得的。结果。 根据比值比测量，髋部骨折风险增加与下肢功能障碍（比值比 = 1.7；95% 置信区间，1.1 至 2.8）、视力障碍（比值比 = 5.1；95% 置信区间，1.9 至 13.9）、既往中风（比值比 = 2.0；95% 置信区间，1.0 至 4.0）、帕金森病（比值比 = 9.4； 95% 置信区间，1.2 至 76.1），以及使用长效巴比妥类药物（比值比 = 5.2；95% 置信区间，0.6 至 45.0）。 在对照组中，44 名（25%）最近曾跌倒过。 病例患者比对照者更有可能从站立高度或更高高度跌倒（比值比 = 2.4；95% 置信区间，1.0 至 5.7）。 在髋部骨折患者中，年轻患者（< 75 岁）比老年患者（大于或等于 75 岁）更有可能跌倒在坚硬的表面上（比值比 = 1.9；95% 置信区间，1.04 至 3.7）。结论。 许多已被确定为跌倒危险因素的因素也与髋部骨折有关，包括下肢功能障碍、神经系统疾病、巴比妥类药物的使用和视力障碍。 鉴于这些问题在风险最高的老年人中普遍存在，预防髋部骨折的计划除了减缓骨质流失的措施外，还应包括预防跌倒的措施。
Background. Although even in the elderly most falls are not associated with fractures, over 90 percent of hip fractures are the result of a fall. Few studies have assessed whether the risk factors for falls are also important risk factors for hip fracture.Methods. To examine the importance of risk factors for falls in the epidemiology of hip fracture, we performed a case-control study of 174 women (median age, 80 years) admitted with a first hip fracture to 1 of 30 hospitals in New York and Philadelphia. Controls, matched to the case patients according to age and hospital, were selected from general surgical and orthopedic surgical hospital services. Information was obtained by direct interview.Results. As measured by the odds ratio, increased risks for hip fracture were associated with lower-limb dysfunction (odds ratio = 1.7; 95 percent confidence interval, 1.1 to 2.8), visual impairment (odds ratio = 5.1; 95 percent confidence interval, 1.9 to 13.9), previous stroke (odds ratio = 2.0; 95 percent confidence interval, 1.0 to 4.0), Parkinson's disease (odds ratio = 9.4; 95 percent confidence interval, 1.2 to 76.1), and use of long-acting barbiturates (odds ratio = 5.2; 95 percent confidence interval, 0.6 to 45.0). Of the controls, 44 (25 percent) had had a recent fall. The case patients were more likely than these controls to have fallen from a standing height or higher (odds ratio = 2.4; 95 percent confidence interval, 1.0 to 5.7). Of those with hip fracture the younger patients (< 75 years old) were more likely than the older ones (greater-than-or-equal-to 75 years old) to have fallen on a hard surface (odds ratio = 1.9; 95 percent confidence interval, 1.04 to 3.7).Conclusions. A number of factors that have been identified as risk factors for falls are also associated with hip fracture, including lower-limb dysfunction, neurologic conditions, barbiturate use, and visual impairment. Given the prevalence of these problems among the elderly, who are at highest risk, programs to prevent hip fracture should include measures to prevent falls in addition to measures to slow bone loss.